SUMMARYOne hundred patients referred to old age psychiatry services in the West Midlands and 25 patients referred to a memory clinic in Bristol with mild to moderate dementia were assessed using the GMSMAS schedule together with a detailed inventory to assess their psychotic symptoms. On careful evaluation one patient did not have dementia. Eighty-three of the other 124 patients (66.9%) had at least one psychotic symptom. The prevalence of psychotic symptoms in the patients from the West Midlands and from the memory clinic in Bristol were extremely similar. Thirty-five per cent had at least one visual hallucination, 12.9% had at least one auditory hallucination, 48.4% had at least one delusional belief and 29.0% had at least one delusional misperception. Most individuals experienced their psychotic symptoms at a frequency between weekly and daily. Twenty-four had no insight into their psychotic symptoms and acted upon them, while only one patient had full insight into their symptoms. Thirty-seven subjects were mildly distressed and 14 were severely distressed by the psychotic symptoms they experienced. There was a trend for patients with cortical Lewy body dementia to be more likely to have psychotic symptoms than patients with Alzheimer's disease or vascular dementia. The symptom profile of psychotic symptoms in the different dementias was, however, very similar. The frequencies of individual psychotic symptoms are described in the text.KEY WORDS-psychotic symptoms; dementia; phenomenology With the increased attention paid to psychotic symptoms in dementia sufferers over the last decade, it appeared that a consensus was developing that between 30 and 45% of dementia sufferers experienced these symptoms (Cummings et al., 1987;Cooper et al., 1991;Burns et al., 1990;Sultzer et al.,

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Purpose -High-secure hospital patients often have complex presentations that are marked by co-morbidity, violence, histories of poor concordance with oral medication, and treatment resistance. The ability to give a long-acting medication with a low propensity for extra pyramidal side effects is of potential value to clinicians treating these patients. Risperidone Long-acting Injection (RLAI) is the first long-acting atypical antipsychotic medication and may be potentially useful in this population. This paper aims to investigate this issue.Design/methodology/approach -This was a retrospective, naturalistic study to investigate the use and effectiveness, using hard outcome measures, of RLAI in the four UK high-secure psychiatric hospitals. Hospital pharmacy databases at Ashworth, Broadmoor, Carstairs and Rampton hospitals were used to identify all patients who had been prescribed RLAI. Anonymised data were then obtained from the pharmacy databases and case notes which were then pooled.Findings -A total of 159 patients were prescribed RLAI, most of whom had schizophrenia. The mean length of treatment with RLAI was 65 weeks (range two to 260 weeks) and the mean maximum dose was 43.2 mg every two weeks (range 25-75 mg every two weeks). No serious adverse effects were reported. In total, 42 per cent (67) patients responded to RLAI in as much as that they either remained on it in the long-term or were discharged to conditions of lower security whilst taking it. As there was no control group, it is not possible to determine if RLAI was a significant factor in such discharges to conditions of lower security. Of those patients who failed to respond to RLAI, 44 per cent were subsequently treated with clozapine.Originality/value -This pragmatic multi-centre study of a small but complex patient group demonstrated that RLAI was effective in 42 per cent of patients and was well-tolerated.